In the fall of 2017, after returning from Nursing Management Congress2017 and the National Conference for Nurse Practitioners, both of which took place in Las Vegas immediately following the mass shooting at the Route 91 Harvest Festival, I received an invitation from my state nurses association to an active shooter training. I felt compelled to attend this training and vowed to write about what I learned here on this blog. I attended the training session and took extensive notes of the valuable lessons I learned. Well, time passed, and that to-do item got pushed down on my list, which both embarrasses me and teaches me a valuable lesson.

Time goes by. While we don’t forget tragedies, over time we do get caught up in the everyday chaos of our lives and think “I’ll get to that later.” On February 14th, the 18th school shooting occurred in the United States since the beginning of 2018. That’s 18 school shootings in 45 days. Unacceptable. We can’t put this on the back burner any longer.

There are many famous quotes about not being able to change others (or the world) without making changes to oneself. So, I challenge you to think about what you can do to address issues related to gun control, mental health, and protecting students, staff, and teachers. What I can do right now is share what I learned from the Pennsylvania State Police back in December of 2017 and share a list of resources to help us all be prepared for an active shooter incident.

Pennsylvania State Nurses Association Active Shooter Training: December 4, 2017
Here are some key takeaways from this presentation:

Many victims say, “I didn’t know what to do,” or “I was just waiting my turn to be shot.” The important lesson here is to tell people in an active shooter situation to do something. Time is a valuable commodity, and by doing something, one takes some time away from the shooter.

63% of active shooter incidents are in commerce or an education environment, but no place is off limits.

Active shooter incidents typically evolve quickly and end (historically) within 10 to 15 minutes; 36% end before the police arrive.

Be prepared:

Mental preparation – Chaos and panic will occur. As best as you are able, trust your instincts, breathe, and remain calm.

Sounding the fire alarm is NOT recommended. The potential negative consequences outweigh the benefit.

People are complacent with fire alarms.

People won’t think “active shooter.”

Role of police – Police officers are there to neutralize the threat, not treat injured.

Three options (you may have to do all three):

Run – If you have an opportunity to escape, do so.

Hide – Don’t let anyone in.

Fight – Fight for your life with whatever you have. There is power in numbers and the shooter is typically not looking for a fight.

It is incumbent upon you to be mindful of these things and know how to react if you are involved in an active shooter situation. Think, if you were to be involved in an active shooter situation tomorrow, would you be able to answer the following:

Are you prepared?

How would you react?

Are others prepared?

Do you know what to expect?

What is your ability to protect?

The final thoughts of the presentation? “Be prepared and plan to survive.”

As caregivers, educators, and advocates, we must understand the differences between palliative care and hospice care so that we can ensure that patients and families are getting appropriate care and services at the appropriate times.

Both palliative care and hospice care require an interdisciplinary approach, with a focus on relieving pain and managing physical and psychological symptoms, while improving quality of life. What differs is that palliative care should begin at the time of diagnosis, when possible, and can be offered at the same time as curative treatments. Hospice care is appropriate for those with a prognosis of six months or less and excludes concurrent curative treatment.

Listen in as Dr. Anne Woods and Lisa Bonsall go more in-depth on the differences and similarities between the two, and why it’s so important for nurses to be part of related conversations with patients, families, and the interdisciplinary team.

Lippincott NursingCenter.com is partnering with Lippincott Solutions to bring you an inspired nurse’s story every month. Here is the January 2018 inspired nurse story, Like Angels and Fairies.

Like Angels and Fairies
Chinazo Echezona-Johnson
Services for the underserved ∙ Vice President of Nursing Services

I did not want to be a nurse. I always wanted to be a lawyer. But then something extraordinary happened. My mom went into labor prematurely, and since there was no one to watch me, I had to go with her to the hospital. While in the waiting room, the nurses played with me and kept me company until my father arrived. In my eight-year-old mind, the nurses looked like fairy-tale characters because they were so kind and caring. They were also immaculately dressed in starched white uniforms, polished white shoes and white caps. They looked like angels and fairies to me.

It was a difficult delivery for my mother, but the love and care she and my baby brother received was magical. I did not see the birth, but when I could finally come in and hold my new little brother, I saw many nurses comforting, mothering and supporting other women in various stages of labor, delivering or recovering from childbirth. These kind nurses did not complain – not even when people were yelling at them. They kept their composure and professionalism at all times and it was at that point that I decided I must become a nurse. And today, after 24-years practicing as an Obstetrical and Gynecology nurse, I can still remember the caring nurses who took care of my mother and brother – those magical nurses who changed my life.

I had the pleasure of speaking with Jessica Emmons, a recent Certified Registered Nurse Anesthetists (CRNA) program graduate who, like many of us, has quite an interesting story to tell of her journey into nursing and to her latest career stop, as a nurse anesthetist. Jessica began her adult life as an accountant and when she was looking for a change, others in healthcare described nursing as an “enviable world.”

During her 12 years as an emergency room nurse, Jessica also worked as a vascular access nurse, where she experienced significant autonomy and decision-making responsibility. As she developed her leadership skills and was sought after for more responsibility, she realized that remaining at the bedside was important to her. She shadowed a colleague in the operating room and had a “wow experience” that drew her to becoming a CRNA.

Please listen in on our conversation to learn more about Jessica, including the human piece of her work as a CRNA, what a typical day is like, and what she means by saying “You never hear about the overly prepared or overly clean nurse on the 5 o’clock news!” Jessica also tells us about the importance of the trust established with a patient in her care and shares an example of providing care to a patient who was not expected to awaken after surgery. Lastly, Jessica has some great advice to anyone considering application to a CRNA program and joining this group of 52,000+ advanced practice nurses!

Happy National CRNA Week!

A 2017 graduate of the Nurse-Anesthesia Program at Drexel University, Jessica Ann Emmons, MSN, CRNA is employed full time with United Anesthesia Services, P.C. and is based out of Paoli Hospital. Her graduate research focused on the second victim phenomenon, and the need for structured peer support after unanticipated adverse outcomes. She continues to speak and present this information at conferences and state meetings in the hopes of creating awareness about this vital topic. In 2003, Jessica earned her ASN from Gwynedd-Mercy College, launching a nursing career and leaving the business world behind. Prior to starting her specialization in anesthesia, Jessica was an emergency department nurse, vascular access specialist, and worked in the neuro-cardiac intensive care unit. Jessica resides in the borough of West Chester, PA with her husband, Will, and their three daughters. In her spare time, Jessica enjoys cooking, bicycling, and quilting, although never all three at once.

We are deep into flu season and the Centers for Disease Control and Prevention is reporting widespread activity across most of the U.S. Influenza especially poses a serious threat to certain populations; however, everyone is at risk for influenza and susceptible to its complications.

To keep your knowledge current and clinical skills sharp, we’ve compiled our must-have content related to influenza and vaccination. Don’t miss a new video from our Chief Nurse, Dr. Anne Woods, an explanation of herd immunity, and recommendations on talking to patients about vaccination.

Influenza is a serious disease that can lead to hospitalization and sometimes even death. Every flu season is different, and as nurses, we need to stay up-to-date on current recommendations to minimize detrimental outcomes. To access these important resources, visit www.nursingcenter.com/influenza today.

Infusion therapy has evolved from an extreme measure used on only the most critically ill to a highly specialized mode of treatment used for 90 percent or more of all hospitalized patients. No longer confined to the hospital setting, infusion therapies are now delivered in alternative care sites, such as homes, skilled nursing facilities, and physicians’ offices.

Nursing involvement in the practice of infusion therapy has become a highly specialized practice. The role of the nurse in infusion therapy has changed a great deal over the past 50 years. Today’s infusion nurse is responsible for integrating the holistic principles of medicine and nursing, management, marketing, education, and performance improvement into the patient's plan of care. Clinical expertise is key. Nurses who specialize in infusion therapy, particularly, certified registered nurses of infusion (CRNI®s), are an integral part of health care teams that provide the correct dose of medication and keep patients safe from catheter-related bloodstream infections and other complications. CRNI®s are part of a global community of elite nurses across multiple disciplines—including home care, pediatrics, oncology, and many more—who have demonstrated through certification that they are the most informed, and most highly qualified infusion nursing specialists. CRNI®s are continuously exposed to the newest advances and latest developments, technologies, and techniques in the infusion nursing specialty.

On January 25, infusion nurses and other health care professionals will observe National IV Nurse Day. Proclaimed by then Massachusetts Congressman Ed Markey in 1980, the U.S. House of Representatives designated this day to honor and recognize the accomplishments of the nation's infusion nurse specialists each year, as well as the Infusion Nurses Society (INS). Markey called the specialty “a vital branch of our nation’s nursing profession.” INS CEO Mary Alexander, MA, RN, CRNI®, CAE, FAAN, stated that "INS and infusion therapy have come a long way in the last 50 years. Medical technology has changed dramatically and today our specialty looks very different. Celebrating IV Nurse Day gives us an opportunity to recognize the evolution of our specialty and the significant contributions that infusion nurses make in their patients' lives."

IV Nurse Day promotes the advancement of the specialty and recognizes decades of continuing education, advocacy, and professional development offered by the infusion nursing community. This year's theme, “It’s About Us. It’s About Infusion,” invites nurses everywhere to commemorate their commitment to their work and to their patients.

It is the perfect opportunity to increase recognition of the specialty, whether displaying IV Nurse Day posters around your medical practice, hosting a CRNI® educational event, or sporting some new IV Nurse Day gear. Order yours at www.jimcolemanstore.com/ins. Email photos of your IV Nurse Day event to ins@ins1.org, and we’ll share them in a future INSider. Happy celebrating!

For more information, visit http://www.ins1.org/IVNurseDay.Leslie Nikou is responsible for managing the manuscript submission process for the Journal of Infusion Nursing from start to finish. She assists in manuscript selection and works with reviewers, authors, and publication staff to deliver polished, relevant content in each print issue. Leslie also oversees the editorial content of INS’ membership publication INSider, as well as other INS-related print and web materials. Prior to joining INS, Leslie served as a multimedia staff editor for a monthly RF/engineering publication. She is also a veteran news and promotions writer/producer, with more than 15 years’ experience in the Boston and Rhode Island television markets. Leslie is an avid photo enthusiast and loves to create scrapbooks detailing the milestones, adventures, holidays, and activities of life with her husband and two daughters. When she’s not busy attending soccer games or dance rehearsals, Leslie enjoys catching up with family and friends, movies, shopping, and planning her family’s next getaway. She can be reached at leslie.nikou@ins1.org

Herd immunity, or community immunity, makes it less easy for communicable diseases to spread, especially to those for whom vaccination is contraindicated. It’s an indirect way to protect individuals through vaccination of the public. Herd immunity protects everyone, but it is especially important for those who can’t get vaccinated – for example, those with life-threatening allergies to any part of the influenza vaccine.

An example of a disruption in herd immunity occurred in the not-so-distant past. If you recall, back in 2015, a measles outbreak began in California when an unvaccinated child was hospitalized with rash. The child’s travel history included a recent visit to a Disney theme park, and within two months, about 125 additional cases were connected with visits to Disneyland (Gould, 2017).

So, what’s the problem? Of late, vaccine safety is being questioned by many and the controversy is getting more attention than the diseases they are intended to prevent. Also, many of us weren’t alive when certain communicable diseases – those for which vaccinations are currently available and recommended – even existed. Most of us haven’t been affected by the crippling effects of polio or the devastation from diphtheria.

While influenza may not seem like a scary illness to some, it can be devastating for others. According to the Centers for Disease Control and Prevention, 6,486 laboratory-confirmed influenza-associated hospitalizations have been reported since October 1, 2017, and 7% (the epidemic threshold) of deaths for the year (up to and including the week ending December 23, 2017) were attributable to pneumonia and influenza. Twenty influenza-related pediatric deaths have been reported during the 2017-2018 influenza season thus far (Centers for Disease Control and Prevention, 2018).

I recently had the privilege of speaking with John W. Bluford, lllFounder and President of the Bluford Healthcare Leadership Institute and President Emeritus of Truman Medical Centers. Mr. Bluford and I discussed the important work of the Nurses on Boards Coalition and how nurses can be leaders in health care.

Listen in on our conversation and hear specific examples from Mr. Bluford of how he has seen the voice of nursing impact change. Mr. Bluford offers some great advice regarding the need for nurses to understand the financial aspects of health care, since we already know our profession as the “business of caring.”

Thank you, Mr. Bluford, for joining me in this conversation and all your important work!

John W. Bluford, III, MBA, FACHEhas a distinguished career in hospital and health system administration. Mr. Bluford is President of the Bluford Healthcare Leadership Institute and former President and CEO of Truman Medical Centers. He is also former Chairman of the American Hospital Association, the National Association of Public Hospitals, and the Missouri Hospital Association. He currently serves on the Board of the National Center for Healthcare Leadership. His extensive career began with his role as a Centers for Disease Control and Prevention (CDC)-trained Epidemiologist, later leading Pilot City Health Center in Minneapolis to become the first JCAH-accredited community health center in the county, and then becoming CEO of Hennepin County Medical Center. Mr. Bluford has received numerous awards and achievements and has presented nationally and internationally on topics related to healthcare leadership and change management. His full biography can be read here.

Perhaps you should’ve made a New Year’s Resolution to make more time to laugh, in all seriousness. It comes as no surprise to learn that laughing can positively impact your mood and quality of life. Though hesitations arise from those in the medical field as to whether laughter should be directly credited for making people feel better, here are five things we surely know about laughter:

2. Laughter cultivates open communication. Several researchers have discoursed laughing as a defense mechanism and coping strategy due to its therapeutic nature and euphoric effects. While evidence supporting laughter improving one’s health remains insufficient or weak in scale, using humor has been attributed to moderating a patient’s pain and credited for creating lines of communication between medical professionals and their patients [Bennett, 2003]. Humor has been shown to diminish the formal exchange of communication and allow patients to feel more comfortable in discussing difficult issues [Bennett, 2003].

3. Laughter releases endorphins. Seeking a runner’s high without running? Laughter can provide a similar effect. Laughing with others has been directly linked to triggering the release of endorphins in the brain, leading to a euphoric-feeling [Arponen et al., 2017]. Studies also show that the more opioid receptors in an individual’s brain, the more potent the euphoric effect [Arponen et al., 2017].

4. Laughter enables long-term relationships. Do you consider laughter as a factor in establishing relationships? Research has shown that endorphin release due to social-induced laughter may contribute to our ability in forming and maintaining social bonds [University of Turku, 2017]. Laughter is highly contagious causing the endorphin response to spread throughout large groups [University of Turku, 2017].

5. Laughter can help boost immune function. Stress can unquestionably take a significant toll on a person’s quality of life. However, research has shown in some instances that mirthful laughter can not only be a way to decrease stress, but also be a way to boost the immune system [Bennett, McCann, Rosenberg & Zeller, 2003]. Perhaps the key to minimizing stress in your daily life is adding a dose of laughter to your routine.

Though we might not be able to say with scientific certainty that laughing directly affects your health, there is certainly no downside to a genuine, hearty laugh. It may not have abilities to cure ailing patients, but it has enough power to uplift someone’s day, attitude, and outlook.

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Views expressed on this blog are solely those of the authors or persons quoted. They do not necessarily reflect Lippincott's NursingCenter.com's views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.